After years of studying systemic racism in hospital emergency care, a team of researchers and First Nations organizations will create ways to ensure all patients are treated equitably and with dignity.
Nation Talk: University of Alberta: For the last six years, First Nations organizations have supported a team of researchers including Bonnie Healy and Patrick McLane to study the quality of care for First Nations members in Alberta’s emergency departments. The results demonstrate systemic racism in emergency care.
Now, eight First Nations organizations are ready to launch the critical next phase of their work to create an anti-racism intervention that will ensure patients needing help will be treated equitably and with dignity. The Alberta First Nations Information Governance Centre, Blackfoot Confederacy Tribal Council, Stoney Nakoda Tsuut’ina Tribal Council, Bigstone Health Commission, Maskwacis Health Services, Paul First Nation Health Services, Yellowhead Tribal Council, and Kee Tas Kee Now Tribal Council are supporting the work.
The project, made possible by a $1.75-million grant from the Canadian Institutes of Health Research, will create several partnerships between Alberta emergency departments and Indigenous organizations, says McLane, an adjunct associate professor in the Faculty of Medicine & Dentistry and assistant scientific director of Alberta Health Services’ Emergency Strategic Clinical Network.
The partnerships will lay the foundation for training hospital staff in anti-racism strategies, changing emergency department processes to help meet the unique needs of each patient and addressing barriers to followup care. “We’re going to build relationships between three emergency departments and a Nation or a First Nations organization that wants to work with that department and direct change in that department,” McLane says. “What I really would like to show is that by making changes in the departments and educating staff and building relationships, we can ultimately impact patient experiences.”
Lea Bill, a registered nurse, Indigenous knowledge holder and executive director of the Alberta First Nations Information Governance Centre, and Esther Tailfeathers, a member of the Kainai Nation and senior medical director of the Provincial Indigenous Wellness Core at Alberta Health Services, are McLane’s co-leads on the new project. The team’s work applies First Nations knowledges, languages and worldviews to contextualize and analyze data, and inform research methods.
“We’re able to see the racism in the data”
Healy, member of the Kainai Nation and health director of the Blackfoot Confederacy Tribal Council, has been working with McLane since 2017. In that time, they and their collaborators have co-authored five studies relating to racism and inequity First Nations people experience when seeking emergency care.
In two of the studies — one published in May 2021, the other in January 2022 — the research team analyzed health records from April 2012 to March 2017. They found that the rate of emergency visits is nearly three times higher for First Nations persons than non-First Nations persons, and First Nations women seek emergency care more than non-First Nations women. The researchers link this higher use of emergency departments to issues in equitable access to appropriate primary and specialty care.
The data also showed many First Nations visits end in patients leaving without completing treatment. And it revealed that First Nations patients with health issues like long bone fractures, acute upper respiratory infections and anxiety had greater odds of receiving less urgent triage scores than comparable non-First Nations patients with the same diagnoses.
“I don’t know if you’ve ever had a long bone fracture, but they’re not pleasant,” says Healy, who has been a nurse for 33 years and is ER trained. “People are walking away with [them]. That shouldn’t be happening anywhere.”
In a third paper, published in June 2022, the researchers interviewed emergency care providers to get their perspectives on care of First Nations patients in emergency. The providers described that First Nations patients are exposed to disrespect through tone and body language, experience overt racism and may be neglected or not taken seriously.
“That was a unique article,” says McLane. “It was non-Indigenous physicians and nurses who we interviewed for the project, and then we were interpreting what they said with First Nations partners like Bonnie. “Instead of western analysts analyzing Indigenous patients, we had First Nations researchers analyzing the words of providers.”
Healy says there is value in having data to confirm what many Indigenous people living in Canada already know. She pointed to examples like Brian Sinclair, who died untreated in a Winnipeg emergency room in 2008, and Joyce Echaquan, an Atikamekw woman who died shortly after livestreaming racist remarks from hospital staff in Quebec. “It’s foundational work because not only did we combine qualitative data and the honest comments by these staff that work in these spaces, but we looked at the quantitative data — the surveillance data that we received from Alberta Health Services — and we’re able to see the racism in the data.”
Creating best practices
In the paper studying providers’ perspectives, Healy, McLane and their co-authors included recommendations for best practices to improve emergency care for First Nations patients. Some of the suggestions:
- Providers must treat each patient as a unique individual when diagnosing health issues, and making decisions about treatment.
- Emergency departments should build formal relationships with First Nations communities.
- Emergency departments should have the resources necessary to offer contextually tailored care and resolve barriers that affect the patient’s continuity of care.
McLane and Healy hope that the project will result in fewer experiences of racism and a greater sense of cultural safety for First Nations people seeking emergency care. In turn, they hope to see fewer instances of First Nations people leaving without having been treated. “I would like to see First Nations, when they do experience racism in any space within health, feel that they will be heard, they will be safe and they can trust the process to report and resolve incidences of these experiences,” says Healy.
As for the $1.75 million in funding, McLane says the intensive effort of this project means it couldn’t go ahead without it. “We’re going to generate data on what works when we attempt to do anti-racism — and really granular data, so that we can look at what made this successful, or unsuccessful if that should be the case,” he says. “That kind of implementation is made possible by the CIHR grant.”
CIHR-funded projects at the U of A
The project is one of 29 at the U of A receiving a total of $17.9 million from CIHR: